November 4, 2008 (San Diego, California) — Breastfeeding is
associated with better intellectual and emotional development than
bottle feeding, according to findings presented here at the American
Public Health Association 136th Annual Meeting.

Parents or guardians of breastfed children were less likely to
express concern about learning capacities, and the children were less
likely to have required treatment for behavioral, conduct, or
mental-health problems, authors Katherine Hobbs Knutson, MD, and Alexy
Arauz Boudreau, MD, MPH, from the Massachusetts General Hospital (MGH)
in Boston, reported in an oral presentation.

Good research supports the association between breastfeeding and
cognitive and intellectual development, but its effect on behavioral
and psychological development are not as well understood, Dr. Knutson,
a psychiatrist at MGH, told Medscape Public Health & Prevention.
"What's new here is that breastfeeding during infancy is
associated with decreased parental concern about behavior, fewer
diagnoses of behavioral or conduct disorder by healthcare
professionals, and [less need for] mental healthcare during
childhood."

The authors drew on data from the National Survey of Children's
Health, which included interviews with more than 100,000 parents and
guardians on the health of their children, who ranged in age from 10
months to 18 years. This study included data on children from 1 to 5
years of age. The parents or guardians were asked if they were
concerned a lot, a little, or not at all about how well the child was
learning to do things for him- or herself; how well the child was
learning preschool or school skills, and how he or she was behaving in
general. Answers indicating any degree of concern were combined for
the analysis. The parents and guardians were also asked whether the
child had ever been diagnosed with conduct or behavioral problems, and
whether the child had ever received any mental-health care or
counseling.

The authors controlled for the child's age, race, sex, and
socioeconomic status, as well as parental education and maternal
mental health.

Breastfeeding was associated with an odds ratio (OR) of 0.77 that
parents or guardians would report concern about the child's ability to
learn for him- or herself, and an OR of 0.76 for the child's ability
to learn preschool skills. It was also associated with less concern
about the child's behavior (OR, 0.85), and a lower likelihood of
medically diagnosed behavior or conduct problems, or receipt of
mental-health care (OR, 0.63 for both).

The reasons for these findings are still unclear, Dr. Knutson said.
"Our study is unable to explain why breastfeeding may affect
behavior, but it is possible that nutrients in human milk may
influence the neurologic mechanisms or psychological development in
children."

Although the authors did control for parental education and
maternal mental health, "mothers who breastfeed are different
than those who do or did not," warned Sheela R. Geraghty, MD, MS,
assistant professor of pediatrics, and medical director of the Center
for breastfeeding Medicine at Cincinnati Children's Hospital Medical
Center in Ohio. "Mothers who breastfeed answer behavioral
expectations about their children differently than those who do
not."

Still, she said, "while the data presented are preliminary,
this abstract highlights [the fact] that parents who reported that
their children were breastfed also reported that their children had
less behavioral and conduct problems," said Dr. Geraghty, who was
not involved in the study. "These findings cannot be causally
linked, but they highlight the point that choices made for the infant
— including the feeding choices — in the early infancy period can
have a lasting impact throughout childhood."